Homepage Legal Do Not Resuscitate Order Form Blank Do Not Resuscitate Order Form for Colorado
Content Overview

The Colorado Do Not Resuscitate Order form serves as a critical document for individuals who wish to express their desire not to receive cardiopulmonary resuscitation (CPR) in the event of a cardiac or respiratory arrest. This legally binding form is an essential component of advance healthcare planning, ensuring that a patient's preferences are respected by healthcare providers. The process to complete and validate the form involves detailed discussions with healthcare professionals, ensuring that the individual is fully informed and consents to the directives stipulated in the form. Furthermore, it addresses the need for clear communication between patients, their families, and medical personnel to ensure that the patient's wishes are understood and honored. The form also plays a pivotal role in clinical settings by providing guidance to healthcare teams during critical moments, thus safeguarding a patient’s autonomy and dignity at the end of life.

Example - Colorado Do Not Resuscitate Order Form

Colorado Do Not Resuscitate Order

This document serves as a direction under the laws of the State of Colorado, specifically referencing the Colorado Medical Orders for Scope of Treatment (MOST) laws, indicating the individual named herein refuses any forms of resuscitation attempts in the event of cardiac or respiratory arrest.

Patient Information

Patient's Full Name: _________________________

Date of Birth: _________________________

Gender: _________________________

Address: _________________________

City, State, Zip: Colorado, ________________

Medical Practitioner's Information

Practitioner's Full Name: _________________________

Qualification: _________________________

License Number: _________________________

Address: _________________________

City, State, Zip: Colorado, ________________

Do Not Resuscitate (DNR) Order

I, _________________________, being of sound mind and understanding the implications, hereby refuse any form of resuscitation including CPR (Cardiopulmonary Resuscitation), advanced cardiac life support, and other life-sustaining interventions in the event I experience cardiac or respiratory arrest, under Colorado law.

This directive is made voluntarily and without any undue influence, understanding fully the consequences of such a decision.

Signature

Patient's Signature: _________________________ Date: ___________________

Witness Signature: _________________________ Date: ___________________

Medical Practitioner's Signature: _________________________ Date: ___________________

Important Information

  • This Do Not Resuscitate Order must be reviewed periodically and may be revoked at any time by the patient or their legally authorized representative.
  • A copy of this order should be provided to and discussed with the patient's health care proxy, family, or others who may be involved in the patient’s health care decisions.
  • This document does not replace the need for other forms of medical treatment that may be beneficial to the patient's wellbeing and comfort.
  • This order is only valid within the State of Colorado.

PDF Form Attributes

Fact Number Detail
1 The Colorado Do Not Resuscitate (DNR) Order form is used by individuals who wish not to receive cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest.
2 This form must be signed by both the patient (or their legally recognized health care decision-maker) and a licensed physician, advanced practice nurse, or physician assistant.
3 Colorado's DNR order is governed by the Colorado Medical Treatment Decision Act, which outlines the rights of patients to refuse medical treatment under certain conditions.
4 The DNR order is effective immediately upon signing and does not expire unless revoked by the patient or their authorized decision-maker.
5 This form should be readily available and presented to healthcare providers to ensure the patient's wishes are honored in an emergency situation.
6 Revocation of the DNR order can be done orally or in writing by the patient or their authorized representative at any time.
7 In addition to the DNR form, patients may consider creating a Medical Durable Power of Attorney and a Living Will, which offer broader control over their medical treatments and end-of-life care.
8 The availability and acceptance of the DNR order may vary among medical facilities; therefore, discussions with healthcare providers about the patient's end-of-life wishes are highly recommended.

Instructions on How to Fill Out Colorado Do Not Resuscitate Order

Completing the Colorado Do Not Resuscitate (DNR) Order form is a significant step for individuals making decisions about their end-of-life care. This process enables Coloradans to express their wishes regarding the extent of medical interventions they desire should they become critically ill and unable to communicate these decisions. It's an act of preparing for the uncertain future, aimed at ensuring that one's healthcare preferences are respected and followed. The steps outlined below will guide you through filling out the form properly to ensure your directives are clearly stated and legally recognized.

  1. Begin by gathering your personal information, including your full legal name, date of birth, and address. This information must be accurately reflected on the form to ensure it uniquely identifies you.
  2. Review the instructions provided on the form carefully. Understanding the scope and implications of the DNR Order is crucial before proceeding.
  3. In the designated section, print your full legal name to indicate the subject of the DNR Order.
  4. Enter your date of birth next to your name to provide verification of your identity and ensure that the order is applied correctly in a medical situation.
  5. Discuss with your healthcare provider the specifics of the DNR Order and its implications for your medical treatment. This conversation is essential for making an informed decision.
  6. Once you have made an informed decision, sign the form in the presence of a witness or a notary, if required by your state's law. The act of signing is what gives the DNR Order its legal effect.
  7. Ask the healthcare provider or the witness to sign the form as well, confirming that you have willingly chosen to issue a DNR Order and that you understand its significance.
  8. Keep the original copy of the completed DNR Order in a place where it can be easily found by family members or emergency personnel. Additionally, consider carrying a wallet card indicating you have a DNR Order.
  9. Inform your family, close friends, and healthcare proxy (if you have one) about your DNR Order. This step is vital to ensure that they understand your wishes and can advocate on your behalf.
  10. Last but not least, provide copies of the signed DNR Order to your healthcare provider(s) and any facilities where you receive care to include in your medical records. This ensures that your healthcare team is aware of your wishes and can honor your DNR Order.

Filling out the Colorado DNR Order form is a proactive measure that communicates your healthcare preferences clearly to both your loved ones and medical providers. By completing each step with care, you can achieve peace of mind knowing that your wishes will be respected during critical healthcare decisions. Remember, while this process involves considering deeply personal choices, it's also an opportunity to have meaningful conversations with those close to you about your healthcare values and desires.

Crucial Points on This Form

What is a Do Not Resuscitate Order in Colorado?

A Do Not Resuscitate (DNR) Order in Colorado is a legal document that tells healthcare professionals not to perform CPR (cardiopulmonary resuscitation) if a person's breathing stops or if their heart stops beating. It is part of a broader approach to end-of-life planning, allowing individuals to express their wishes regarding the types of lifesaving or prolonging treatments they would like to receive, or not receive, during a medical emergency.

How do I get a DNR Order in Colorado?

To obtain a DNR Order in Colorado, you must first discuss your wishes with your healthcare provider. If they agree that a DNR Order is appropriate given your health status, they will fill out the form on your behalf. This document must then be signed by both you and the healthcare provider to be legally valid.

Is a Do Not Resuscitate Order permanent?

No, a DNR Order is not permanent. Individuals can change their minds at any time and can cancel their DNR Order by informing their healthcare provider of their wish to do so. It’s important to communicate this change with all involved parties, including family members and other caregivers, to ensure everyone is aware of your current wishes.

Who should consider a DNR Order?

DNR Orders are typically considered by individuals with severe illnesses, those who are at the end of their life, or people who do not wish to receive CPR for personal reasons. However, it is a very personal decision and should be made after thorough discussion with healthcare providers and family members.

Does a DNR Order affect other treatments?

No, a DNR Order specifically relates to CPR and does not impact other treatments. Individuals with a DNR Order can still receive medications, surgeries, or other forms of care aimed at providing comfort or treating health conditions. It only indicates that CPR should not be administered in the event of cardiac or respiratory arrest.

Can family members overturn a DNR Order in Colorado?

In Colorado, family members cannot override a valid DNR Order unless they have legal authority, such as holding a Power of Attorney for healthcare decisions, and even then, it would be based on the premise that they are acting according to the patient's wishes. It is crucial for individuals to discuss their wishes regarding a DNR Order with their family to prevent misunderstandings during an emergency.

Where should I keep my DNR Order?

Your DNR Order should be kept in a place where it is easily accessible to emergency responders, such as on your refrigerator or in your wallet. Additionally, consider giving a copy to your primary healthcare provider, local hospital, and any health proxies or family members who are likely to be involved in your care.

Is a Colorado DNR Order valid in other states?

The validity of a Colorado DNR Order in other states varies as each state has its own laws and forms for DNR Orders. If you spend significant time outside of Colorado or plan to move, it's advisable to review the laws in the other state(s) and obtain a DNR Order that complies with those state requirements if necessary.

Common mistakes

Filling out a Colorado Do Not Resuscitate (DNR) Order form is a serious step that requires attention to detail. However, mistakes can be made. Recognizing and avoiding these errors ensures the intentions of the individual are clearly understood and respected.

  1. Not consulting with a healthcare provider: A DNR form is a medical order and must be discussed with a healthcare provider to ensure it aligns with the individual's health status and end-of-life wishes.
  2. Leaving signature areas blank: Both the individual and a witness or healthcare provider must sign the DNR form. Missing signatures can invalidate the document.
  3. Incorrect personal information: Providing inaccurate information, such as a wrong date of birth or name, can lead to confusion and delay in the execution of the order.
  4. Using unofficial forms: The state of Colorado provides a specific DNR form that should be used. Alternative or outdated forms might not be recognized.
  5. Not specifying the order's applicability: The form should clearly state when the DNR order is to take effect, under what specific health conditions, to prevent any ambiguity.
  6. Failing to distribute copies: The individual should ensure copies of the completed DNR form are given to their healthcare provider, hospital, and family members.
  7. Forgetting to review and update: Health situations can change. Regularly reviewing and updating the DNR order ensures it still reflects the person's current wishes.
  8. Lack of clarity in details: Writing should be clear and legible. Unclear handwriting or incomplete details can create confusion.
  9. Not considering all options: Before completing a DNR form, explore all end-of-life care options. Rushing into this decision without thorough understanding can lead to regret.

Being aware of these mistakes and carefully preparing your DNR order will help in conveying your health care preferences accurately and ensure they are respected.

Documents used along the form

When managing healthcare preferences, especially in situations requiring a Do Not Resuscitate (DNR) Order in Colorado, individuals often need to complement this document with other forms and documents. These additional items ensure that a person's healthcare wishes are fully articulated, legally documented, and easily accessible to healthcare providers, legal representatives, and family members. Below is a list of documents commonly used alongside a Colorado DNR Order, each serving a unique but complementary purpose in holistic healthcare planning.

  • Advanced Directive/Living Will: An Advanced Directive or a Living Will allows individuals to outline their wishes regarding end-of-life care, including the extent of medical interventions they desire if they become unable to communicate their decisions due to illness or incapacity.
  • Medical Power of Attorney: This legal document designates another person, known as a healthcare proxy or agent, to make healthcare decisions on behalf of the individual if they are incapable of making decisions for themselves.
  • HIPAA Authorization Form: The Health Insurance Portability and Accountability Act (HIPAA) form grants designated individuals the right to access someone's healthcare information, which can be crucial for making informed medical decisions on their behalf.
  • POST Form (Physician Orders for Scope of Treatment): Similar to a DNR, a POST form provides specific instructions about medical treatment preferences in various scenarios, but it is more comprehensive and applies to patients with serious illnesses or frailty.
  • Emergency Medical Information Form: This form contains critical health information, such as allergies, current medications, and specific medical conditions, readily available to emergency responders or healthcare providers.
  • Organ and Tissue Donation Form: Individuals can record their wishes about organ and tissue donation on this form, making their intentions clear to family members and healthcare providers.
  • Healthcare Instructions: This document supplements an Advanced Directive by providing more detailed instructions about healthcare preferences, including conditions that may not be covered by a standard Living Will.
  • Guardianship Agreement: If there are dependents involved, a Guardianship Agreement can designate legal guardianship for minors or dependent adults, ensuring their care and decision-making are under the guidance of a trusted individual if the parent or primary guardian is incapacitated.
  • Financial Power of Attorney: While not directly related to healthcare, this document is crucial as it designates someone to manage financial affairs, ensuring that healthcare and living expenses can be paid for without legal hindrance.
  • Personal Property Memorandum: Though primarily dealing with the distribution of an individual's personal property after death, this document can relieve family members of additional decision-making burdens during a difficult time.

Combining a Colorado DNR Order with these additional forms can ensure a comprehensive approach to healthcare and end-of-life planning. It's advisable to consult with healthcare professionals and a legal advisor to ensure that all documents are properly executed and reflect the individual's wishes accurately. These measures not only provide peace of mind to the individual but also to their family members and healthcare providers by clearly outlining their healthcare preferences and legal rights.

Similar forms

  • Living Will: Similar to a Do Not Resuscitate (DNR) order, a living will lets individuals express their wishes regarding medical treatment if they're unable to communicate those desires themselves. This document can specify conditions under which they do not want life-sustaining treatment, like mechanical ventilation or artificial nutrition, which overlaps the purpose of a DNR.

  • Medical Power of Attorney (POA): This document appoints someone to make healthcare decisions on behalf of the individual if they become incapacitated. While it covers a broader scope than a DNR, both documents empower an individual to have control over their medical treatment when they cannot speak for themselves.

  • Physician Orders for Life-Sustaining Treatment (POLST): Like a DNR, the POLST is designed to communicate a patient's wishes regarding end-of-life care treatments, including resuscitation. The POLST complements a DNR by providing additional instructions about other forms of life-sustaining treatment, not just resuscitation.

  • Advance Healthcare Directive: This is a broader document that may include aspects of a living will and medical POA. It outlines what kind of care the individual desires at the end of their life, including whether they want life-sustaining procedures such as those refused by a DNR order.

  • Five Wishes Document: Going beyond the typical medical and legal language to address personal, emotional, and spiritual needs, the Five Wishes document complements a DNR by providing a comprehensive guide to a person's wishes concerning their medical treatment, comfort, and how they want to be remembered, often including a section on the refusal of life-sustaining treatment.

Dos and Don'ts

In the state of Colorado, a Do Not Resuscitate (DNR) Order is a critical document. It communicates a patient's wish not to receive cardiopulmonary resuscitation (CPR) in the event that their breathing stops or their heart ceases beating. Filling out this form correctly is paramount to ensuring that these wishes are respected. Here are five things you should do and five things you shouldn't do when completing this form.

What You Should Do

  1. Consult with a healthcare provider: Before completing the form, have a conversation with a doctor or nurse practitioner who can explain the implications of a DNR order.
  2. Use accurate personal information: Ensure that the patient's name, date of birth, and other personal information are correctly filled out to avoid any confusion.
  3. Ensure proper authorization: The form must be signed by the patient (or their legal healthcare decision-maker if the patient is unable) and the authorized healthcare provider to be valid.
  4. Keep the form accessible: Once completed, the DNR order should be kept in a location where it can be easily found by emergency personnel or healthcare providers, like at the bedside or with the patient’s identification.
  5. Inform family members: Discuss the decision with family members and other loved ones to ensure they understand the patient's wishes and the existence of the DNR order.

What You Shouldn't Do

  1. Wait for an emergency: Don’t wait until a medical crisis to make these decisions. Have discussions and complete the form well in advance.
  2. Fill it out under pressure: Make sure the decision to complete a DNR order is well-considered and free from external pressure.
  3. Forget to review and update: If the patient’s health status or wishes change, the DNR order should be reviewed and possibly revised to reflect the current preferences.
  4. Overlook state-specific requirements: Each state has its own rules regarding DNR orders. Don’t assume the requirements are the same everywhere; understand Colorado's specific requirements.
  5. Assume it covers all treatments: Understand that a DNR order specifically relates to CPR and does not address other types of medical intervention or palliative care.

Misconceptions

Many people have misunderstandings about the Colorado Do Not Resuscitate (DNR) Order form. These misconceptions can affect decisions and discussions about end-of-life care. It's essential to clear up these misunderstandings to ensure individuals make informed decisions about their healthcare. Here are five common misconceptions explained:

  • All emergency medical services will honor a Colorado DNR Order. While the intention is for emergency personnel to follow these orders, in chaotic or unclear situations, such as if the DNR order is not immediately available or if the first responders are not notified of its existence, they might proceed with life-saving measures. It’s crucial for individuals and their families to make the DNR order readily accessible and communicate their wishes clearly to all healthcare providers.
  • Having a DNR Order means you will not receive any medical treatment. This is not accurate. A DNR Order specifically addresses not initiating CPR (cardiopulmonary resuscitation) if breathing stops or the heart stops beating. It does not mean medical care is withheld for other conditions or illnesses. Patients with a DNR can still receive antibiotics, pain management, hydration, nutrition, and other treatments to maintain comfort and care.
  • Only the elderly or terminally ill can have a DNR Order. This misconception is widespread, but any adult can request a DNR Order. The decision is based on personal beliefs, values, and specific health care goals rather than age or current health status. It's about having control over how medical care is administered, especially in emergency situations.
  • A verbal statement is enough to enforce a DNR Order. In Colorado, a formal, documented DNR Order is required. While conversations with family members and healthcare providers are crucial, they are not legally binding without the documentation that specifically outlines the individual’s wishes. This document should be signed by both the individual and their physician.
  • Once you have a DNR Order, it cannot be changed. Actually, a person can revoke or change their DNR Order at any time. It’s important for individuals to regularly review their wishes and healthcare plans with their family and healthcare providers to ensure their current desires are accurately reflected in their DNR Order.

Understanding these points about the Colorado DNR Order form helps individuals and their families make more informed decisions regarding end-of-life care. Knowledge empowers people to advocate for the type of care they wish to receive or decline, particularly in emergency situations where they may not be able to speak for themselves.

Key takeaways

Understanding the Colorado Do Not Resuscitate (DNR) Order form is crucial for individuals making informed decisions about end-of-life care. Below are five key takeaways to guide you through the process of filling out and using the DNR form:

  • The DNR order must be signed by a healthcare provider to be valid. This ensures that the decision is made in consultation with a medical professional who can provide insight into the individual's health status.
  • The form should be easily accessible in an emergency. Ideally, it should be placed in a location where emergency medical technicians (EMTs) or other healthcare providers can quickly find it during an emergency situation at home.
  • Discuss your wishes with your family and healthcare proxy (if you have one). Clear communication ensures that your loved ones understand your preferences and can advocate for your wishes in situations where you might be unable to speak for yourself.
  • A Colorado DNR order is specific to the state. If you travel or move, check the requirements and validity of your DNR order in the new location. Laws and regulations can vary significantly from state to state.
  • Review and update your DNR order regularly. Over time, your health situation or preferences for end-of-life care might change. It's important to review the document periodically and make necessary adjustments in consultation with your healthcare provider.
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